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PANCE Review > PANCE - GI review > Flashcards

PANCE - GI review Flashcards

1
Q

what antibiotic is a major cause of biliary sludge

A

ceftriaxone

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2
Q

boas sign

A

referred right subscapular pain of biliary colic

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3
Q

patho of cholangitis

A

ascending infxn due to an obstruction in the common bile duct

MC organism: E. coli

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4
Q

charcot’s triad

A
  • RUQ pain
  • fever
  • jaundice
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5
Q

reynold’s pentad

A
  • hypotension
  • AMS
  • RUQ pain
  • fever
  • jaundice
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6
Q

tx of cholangitis

A

ERCP + cipro + metronidazole

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7
Q

patho or primary sclerosing cholangitis

A

chronic liver dz characterized by inflammation and fibrosis of intrahepatic and extrahepatic bile ducts

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8
Q

primary sclerosing cholangitis is assoc with

A

UC

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9
Q

dx of primary sclerosing cholangitis

A

cholangiography
- fibrosis of bile ducts w dilation between strictures

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10
Q

tx of primary sclerosing cholangitis

A

liver transplant

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11
Q

primary sclerosing cholangitis presentation

A

pruritus + jaundice

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12
Q

anal fissure patho

A

develop secondary to local ischemia caused by hypertonia of internal sphincter

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13
Q

dx anal fissure

A

hx & visual inspection w anoscopy

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14
Q

tx of anal fissure

A

combo of supportive care AND topical vasodilator
- nifedipine or nitroglycerin

2nd line:
- topical CCB (diltiazem 2%)
- botox

failure of conservative tx & symptoms > 8 weeks
- lateral internal sphincterotomy

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15
Q

dx of anorectal fistula

A

anoscopy

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16
Q

tx of anorectal fistula

A

SURGERY
- fistulotomy w or w/out marsupialization

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17
Q

where does bleeding occur in diverticulosis

A

MCC of LOWER GI bleed

bleeding distal to the ligament of Treitz

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18
Q

MC location of diverticulosis

A

sigmoid (descending) colon

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19
Q

diverticulitis triad

A
  • LLQ pain
  • fever
  • leukocytosis
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20
Q

how to dx diverticulitis

A

CT w oral and IV contrast
- fat stranding
- bowel wall thickening >4mm

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21
Q

clinical prediction rule for diverticulitis

A
  • absence of vomiting
  • CRP > 5 mg/dL
  • LLQ pain

all 3 = positive result

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22
Q

diverticulitis complications

A
  • abscess formation
  • fistula formation
    *bladder –> colon
  • SBO
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23
Q

MCC of rectal bleeding in pts < 50

A

hemorrhoids

24
Q

internal hemorrhoids arise from

A

superior hemorrhoidal cushion

above dentate line and covered by columnar cells

25
Q

how to dx internal hemorrhoids

A

anoscopy

26
Q

internal hemorrhoid tx

A

symptomatic care:
- stool softeners
- warm sitz bath
- lidocaine ointment or witch hazel

bleeding internal hemorrhoid:
- sclerotherapy injection

prolapsed:
- rubber band ligation

grade IV hem:
- hemorrhoidectomy

27
Q

inflammatory bowel diseases are MC in which population

A

Ashkenazi Jewish population

28
Q

smoking in IBD

A

INCREASED risk of Crohn’s disease in smokers
*C for Cigarettes

DECREASES flares in UC

29
Q

transmural inflammation meaning

A

affects ALL layers of intestinal mucosa

crohn’s affects ANY part of GI tract
*mouth to anus

30
Q

what is spared in crohn’s

A

rectum!!!

31
Q

crohn’s presentation

A
  • RLQ pain
  • NON-bloody diarrhea*
  • aphthous ulcers*
  • fistula
  • B12 & iron def anemia
  • weight loss due to malabsorption
32
Q

colonoscopy findings for crohns

A

skip lesions (cobblestone appearance)
- NON-continuous areas of inflammation

creeping fat
- pathognomonic
- mesenteric fat that migrates to the bowel

33
Q

biopsy findings for crohn’s

A
  • transmural inflammation
  • granuloma!!!
34
Q

rectum is ALWAYS affected in what dz

A

UC!

35
Q

Rome IV Criteria

A
  • related to defecation
  • change in freq of stool
  • change in form of stool

abd pain at least once a wk for 3 consecutive months

36
Q

tx for IBS-C

A

polyethylene glycol

lactulose

linaclotide

lubiprostone

37
Q

tx for IBS-D

A

loperamide

cholestyramine

eluxadoline

38
Q

tx for abd pain / bloating in IBS

A

dicyclomine

hyoscyamine

39
Q

radiographic features of button battery

A

halo or double ring around the circular object
- seen on anteroposterior view

40
Q

tx of button battery ingestion

A

emergency endoscopic removal

41
Q

when to screen patients with UC for colon cancer

A

start screening 8-10 years AFTER dx

colonoscopy q 1-3 yrs

42
Q

colon CA screening in patients with a positive 1st degree relative

A

colonoscopy at age 40 OR 10 years prior to age of diagnosis of FDR, whichever comes 1st

repeat q 5 years

43
Q

colon CA screening

A

screen adults 45-75

OR

at age 40 OR 10 years prior to age of diagnosis of FDR, whichever comes 1st

44
Q

MC type of colon CA

A

adenocarcinoma

patho:
- progression of adenomatous polyps into adenocarcinoma of colon or rectum

45
Q

RIGHT sided (ascending) colon CA symptoms

A
  • iron def anemia
  • occult blood loss
  • melena (upper GI bleed)
46
Q

LEFT sided (descending) colon CA symptoms

A
  • changes in bowel habits
  • hematochezia (lower GI bleed)
  • SBO

*left sided colon CA in MC than right sided

47
Q

colon CA screening methods: when to repeat a FIT

A

q year

  • antibodies are detected in blood
48
Q

colon CA screening methods: when to repeat a FIT-DNA

A

q 1-3 years

49
Q

colon CA screening methods: when to repeat a flexible sigmoidoscopy

A

q 5 years

only examines distal 3rd of colon

50
Q

colon CA screening methods: when to repeat a CT colonography

A

q 5 years

51
Q

patho of phenylketouria (PKU)

A

absent phenylalanine hydroxylase (PAH) enzyme activity

phenylalanine accumulates in CNS leading to mental retardation & mvmt d/o

52
Q

PKU presentation

A
  • blonde, blue eyed w fair skin
  • mousy, musty odor
  • wide spaced teeth
53
Q

dx of PKU

A

newborn screen 24-48 hrs after 1st feed
- plasma phenylalanine levels > 20 mg/dL

54
Q

tx of PKU

A

dietary phenylalanine restriction & increased dietary tyrosine intake

55
Q
A

PANCE Review (7 decks)

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